Columbia Sunrise Hospital and Medical Center in Las Vegas, one of its 128 institutions Columbia/HCA Healthcare Corp. hailed for having achieved "accreditation with commendation," has lost that preferred accreditation status after two new surveys turned up serious deficiencies in patient care.
On Oct. 24, the Joint Commission on Accreditation of Healthcare Organizations downgraded the hospital to "accredited with recommendations for improvement." The change follows two special site visits July 9 and Sept. 19. The JCAHO's accreditation committee listed four "Type I" recommendations, the most serious kind of violation.
The downgrade is a victory for the Service Employees International Union, which is aggressively trying to organize workers at the hospital. More than a year ago, as the hospital was about to go through its triennial accreditation survey, the SEIU tried to alert the JCAHO to alleged patient-care problems. The SEIU was dissatisfied with the Joint Commission's response and was outraged that the hospital was awarded "commendation."
It has been working ever since to convince the Oakbrook Terrace, Ill.-based accrediting agency that its surveyors did not see the true conditions in the 643-bed hospital.
Steve Askin, an SEIU researcher in Washington, said: "We're impressed. JCAHO seems to have changed its position. At first, we did not feel that the information provided by workers was being taken seriously. But when we made a disciplined effort to provide detailed information to JCAHO, they took a serious look at this facility. They appear to have concluded that it does indeed have a need for improvement."
Ann Lynch, the hospital's vice president for community relations, said she thought the special surveyors looked at three areas in the hospital: the laboratory, some nursing floors and the emergency room. She doesn't know what they were looking at in those three places or what they found.
The hospital, she said, has won numerous quality awards. "We take this very seriously and are waiting to hear exactly what the recommendations are," she said. "We continually want to improve. If other people find things they feel we can improve on, we welcome that."
Adair Dammann, an SEIU organizer in Las Vegas, said it took a true unannounced visit to convince JCAHO surveyors that things were not as they appeared in the regular survey a year ago. The SEIU has complained steadfastly that hospitals polish up before the surveyors arrive, giving a false impression of daily conditions.
The SEIU says the July visit wasn't really unannounced because the hospital was given notice. However, on Sept. 19 JCAHO surveyors showed up at the emergency room without having told the hospital ahead of time. What they saw, Dammann said, "was different from what the Joint Commission had seen previously."
Janet McIntyre, spokeswoman for the JCAHO, said organizations are supposed to remain in compliance with the standards throughout the survey cycle.
"We do random unannounced surveys on a 5% sampling. Any time we receive information that reflects threats to patient care or patient safety, a survey team can be sent in. Certainly, we did receive information that caused us to go back and take a look."
The JCAHO declined to say whether the SEIU's complaints motivated the special visits.
In April a patient died at Columbia Sunrise from a blood transfusion reaction. HCFA investigated that accident, and the hospital subsequently changed its patient identification policies and hired a phlebotomy supervisor (Sept. 15, p. 17). The Joint Commission interpreted that incident as a sentinel event.
The drumbeat of bad publicity is taking its toll on hospital workers. On Oct. 26 the hospital published a two-page advertisement in a local newspaper taking issue with an expose by ABC-TV's "20/20" (See graphic).
McIntyre said the Type I recommendations involved initial assessment, medication use, departmental leadership and human resources planning. The hospital will be resurveyed in six months to make sure it has acted on the recommendations. If the JCAHO is satisfied, Sunrise will return to fully "accredited" status but will no longer have commendation.
Like other hospitals across the country, Columbia has used the commendation recognition as a marketing tool. The chain's World Wide Web site lists all 128 of its 341 hospitals that are accredited with commendation.
Columbia has used this fact to counter claims that it cuts quality and staffing to make more money. A page in the Columbia Fact Book asserts that 36% of Columbia hospitals have commendation, while only 8.5% of non-Columbia hospitals do.
That infuriated the SEIU, which alleged that only some kind of nefarious, back-door dealings between the JCAHO and Columbia could produce such unusual results.